HomeMy WebLinkAboutAge_Waltonn.n z AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
REQUESTING DEDUCTION FROM ASSESSED VALUATION
S,��� � State Fwm 43708 (RS / 6O3)
Presaibed by the Departrnem af Laal Gavemment Finance
Infortna6on coatained in this document is CONFIDENTIAL pursuant to IC 6-1.7-72-9.
COUNTY TOWNSHIP YEAR
File Mark
�fRUCTIONS: A S:
To 6e (led in person or 6y mail with the County Auditor o/ fhe counry where ��p�rty�n he months before May
the property is located. 11 1 r�-be ion �s to be eHective.
2) Mo6ile,f�o,.(� s sed under I.C.6-1-1-7;
See reverse side for additional inshucfion and qualifications. be�e�n la�a� and March 31 0/ the year
fhe deduction is�to be eNective.
Name ot applicant ner or conhaG buye
Is apP�icant the ol egal or quitable wne(1
�.Yes ❑ No
If name on record is difrarent than that af appliran
Name of contract Ile (applicant must have beei
Address ot conVact Iler
residence?
If No, wTiat is KsRier exad share or interesi?
on contract at least one
Key number / Legal description
`� Yes �lo
Was the applicant 65 years of age or more on December 31 of e year
priortothe currentyear?
�Yes ❑ No
AppfiwnPs date o(
If filed by a surviving, unmarrie spouse, what was the spouse's age at
the time of death?
you filed tor any
you filed for deductions in any
❑ Yes
❑ No
5
I with someone othar ihan spouse,
vriN whom
Is the property in question:
❑ Real property ❑ Mobile home (I.C_ 6-7-7-�
Assessed value of the property as of March 1, curtent year
exceed $144,000J
nof
$ �
INJe certify under penalty of perjury that ihe above and toregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
�nature of ano�iwnt , Signature of authorized representative (by executed Power ofAttomey)
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